Circuit party attendance, club drug use, and unsafe sex in gay men
Introduction
In most large metropolitan areas, there are several gay clubs (some of which may function primarily on weekends) characterized by dancing, light shows, and live or recorded music played by disk jockeys. In addition, across the US and Canada, circuit parties, events that are usually annual in any location, may attract from 15,000 to 25,000 men and be characterized by spectacular laser shows, music designed to enhance the effect of the shows, and the drugs commonly taken to enhance the whole experience (Lewis & Ross, 1995). It has been estimated (Electric Dreams Foundation, personal communication) that there are 75 such events per year in the US and Canada. Several years ago, an estimated 150,000 to 200,000 gay men in the US paid for tickets to attend these parties, and ticket sales continue to rise. Since the inception of the parties, a regular “circuit” of the most famous ones has developed. Despite differences in regularity, location, and size, clubs and circuit parties are common venues for the use of “club drugs.” The most common of these are methylenedioxymethamphetamine (Ecstasy), ketamine (Special K), methamphetamine (crystal meth), and most recently γ-hydroxybutyrate (GHB) (Li et al., 1998), along with more common drugs of abuse such as cocaine, marijuana, and alcohol. In April 2000, the President of the Gay and Lesbian Medical Association called for urgent research on the “devastating results in our emergency rooms” of club drugs, specifically GHB, and noted their “severe increase” (Frontiers Newsmagazine, 2000).
Ostrow (2000) argues that drugs may facilitate HIV-unsafe sexual behaviors by decreasing both anxiety and self-observation, which may otherwise inhibit pleasurable sexual experiences. They may also provide a “scripted” release from internal, social, and peer group norms, thus resulting in more automatic behaviors that are more rewarding because awareness of their consequences is diminished. Using a case-control approach to HIV seroconversion, nitrite and cocaine use were the significant independent risk factors for infection once receptive anal exposures and condom use were controlled for (Ostrow, DiFranceisco, Chmiel, Wagstaff, & Welsch, 1995). Ostrow and McKirnan (1997) argue that taken together, these observations suggest that the association between drug use and unprotected anal sex could account for a significant proportion of new HIV seroconversions taking place in this population of drug-using homosexual men. They also note that the patterns of sexual risk and drug use in this population are clearly episodic rather than consistent. Such episodes include circuit parties.
A factor adding to their risk of adverse effects is that drugs are rarely used singly. McNall and Remafedi (1999) conducted an analysis of data derived from nine annual cross-sectional surveys on 877 young (≤21) homosexual and bisexual men in Minneapolis–St. Paul. Clustering study subjects into groups by drug use revealed three distinct clusters of drug users: those who primarily used alcohol; those who used mostly alcohol and marijuana; and those who used cocaine, alcohol, marijuana, and a variety of other substances. These data are consistent with those of Chesney, Barrett, and Stall (1998) on homosexual male HIV seroconverters in San Francisco. They followed a sample of 337 baseline HIV-negative men for 6 years, controlling for needle use, and reported that men who have sex with men (MSM) who seroconverted were consistently likely to report use of marijuana, volatile nitrites (“poppers”), amphetamines, and cocaine than were matched MSM who did not seroconvert. Chesney et al. suggest that the mechanisms leading to seroconversion may include (1) stimulants and inhalants increasing arousal and delaying ejaculation, (2) the disinhibitory effects of substance use, and (3) substance abuse and high-risk sexual behavior occurring within long-standing social networks, so that sexual mixing in such networks results in increased seroconversion if unprotected anal intercourse is a norm and there is a high background prevalence of HIV (Chesney et al., 1998).
Apart from the largely qualitative work of Lewis and Ross (1995) on drug use and HIV risk behavior in circuit parties, there are no research data on the prevalence of use of club drugs, the demographics of men who attend circuit parties, or the association of club drugs with unsafe sex. We present a preliminary report on these questions.
Section snippets
Methods
The first author collected data at three major circuit parties in North America in 1998–1999 in diverse geographical areas of the country. The estimated attendance of the three parties, all of which were held over holiday weekends, were 25,000, 15,000 and 10,000, respectively. All data collection was undertaken with the active support of the party producers and based on a two-page, 16-item questionnaire derived from 24 preliminary interviews with party patrons and previous research. It took on
Analyses
The data were subject to calculation of simple frequencies and percentages. A binary measure of unsafe sex was computed from the questions asking for number of instances of unprotected anal insertive and receptive sex in the past 12 months. Levels of unsafe sex in the past 12 months were also cross-tabulated with drugs individually, and Pearson χ2 Tests were used to evaluate the relationship between the two variables. A multivariate logistic regression was also performed, predicting unsafe sex
Results
The demographic summary of party patrons is presented in Table 1. It shows that, on average, one is dealing with a relatively wealthy and well-educated cohort at circuit parties. Looking at HIV serostatus, 80% of those interviewed were HIV-negative, 13% HIV-positive, 4% had been tested but did not know, and 3% had never been tested.
Over half of the party patrons reported use of alcohol (79%), Ecstasy (72%), and Special K (60%) at parties in the past 12 months. Over a third reported using
Discussion
These data offer a closer look at the relationship between substance use and unsafe sex in a group of circuit party patrons who are well educated and economically comfortable. These patrons are part of a “party circuit”, with multiple party attendance and drug use being the norm. It is interesting that the reasons for party attendance appeared to also predict unsafe sexual behavior, with attending “to have sex,” to be “uninhibited and wild,” and “to look and feel good” all predicting higher
Acknowledgements
The HIV Neurobehavioral Research Center (HNRC) is supported by Center award P50-MH 45294 from NIMH.
References (8)
- et al.
A tale of novel intoxication: seven cases of γ-hydroxybutyric acid overdose
Annals of Emergency Medicine
(1998) - et al.
Histories of substance abuse and risk behavior: precursors to HIV seroconversion in homosexual men
American Journal of Public Health
(1998) Dying to party
Frontiers Newsmagazine
(2000)- et al.
A select body: the gay dance party subculture and the HIV/AIDS pandemic
(1995)
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The San Diego HIV Neurobehavioral Research Center [HNRC] group is affiliated with the University of California-San Diego, the Naval Hospital San Diego, and the San Diego Veterans Affairs Healthcare System and includes: Igor Grant, MD (Director); J. Hampton Atkinson, MD and J. Allen McCutchan, MD (Co-Directors); Thomas D. Marcotte, PhD (Center Manager); Naval Hospital San Diego: Mark R. Wallace, MD (P.I.); Neuromedical Component: J. Allen McCutchan, MD (P.I.), Ronald J. Ellis, MD, Scott Letendre, MD, Rachel Schrier, PhD; Neurobehavioral Component: Robert K. Heaton, PhD (P.I.), Mariana Cherner, PhD, Julie Rippeth, PhD; Imaging Component: Terry Jernigan, PhD (P.I.), John Hesselink, MD; Neuropathology Component: Eliezer Masliah, MD (P.I.); Clinical Trials Component: J. Allen McCutchan, MD, J. Hampton Atkinson, MD, Ronald J. Ellis, MD, PhD, Scott Letendre, MD; Data Management Unit: Daniel R. Masys, MD (P.I.), Michelle Frybarger, BA (Data Systems Manager); Statistics Unit: Ian Abramson, PhD (P.I.), Reena Deutsch, PhD, Tanya Wolfson, MA.